Department of Breast and Endocrine Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan.
Ann Surg Oncol. 2022 May;29(5):3000-3010. doi: 10.1245/s10434-021-11212-6. Epub 2022 Jan 7.
Although neoadjuvant chemotherapy (NAC) has become common for breast cancer, its impact on short-term surgical outcomes and the feasible chemotherapy-surgery interval remain unclear. Using a Japanese nationwide database, this study investigated the impact of NAC on short-term outcomes following breast cancer surgery.
In this study of 11,722 patients with NAC and 120,538 patients without NAC who underwent surgery for stage 0-III breast cancer July 2010-March 2017, to cancel out site-specific effects, we generated a 1:4 matched-pair cohort matched for age, institution, and fiscal year of admission. We then conducted multivariable analyses adjusting for potential confounders to compare postoperative complications, duration of anesthesia, and total hospitalization costs. Additionally, we conducted three sensitivity analyses for patients with a short interval from NAC to surgery, patients receiving a particular NAC regimen, and patients undergoing a particular surgical procedure.
In total, the occurrence of postoperative complications was 6.0%, and the median interval from NAC to surgery was 31 (interquartile range, 24-39) days. The two groups did not differ significantly in terms of complications (odds ratio, 0.95; 95% confidence interval, 0.88-1.04), including local and general complications. NAC was significantly associated with shorter duration of anesthesia and lower total hospitalization costs. The sensitivity analyses showed similar results.
Our matched-pair cohort analyses revealed no significant differences in postoperative complications between patients with and without NAC for breast cancer, regardless of the interval, regimen, and surgical procedure. Patients can safely receive surgery and NAC without a lengthened interval.
尽管新辅助化疗（NAC）已在乳腺癌中广泛应用，但它对短期手术结果的影响以及可行的化疗-手术间隔时间仍不清楚。本研究使用日本全国性数据库，调查了 NAC 对乳腺癌手术后短期结局的影响。
在这项研究中，纳入了 11722 例接受 NAC 治疗且 120538 例未接受 NAC 治疗的接受 0-III 期乳腺癌手术的患者。为了消除部位特异性影响，我们按年龄、机构和入院财政年度生成了 1:4 的匹配对队列。然后，我们进行了多变量分析，以调整潜在混杂因素，比较术后并发症、麻醉持续时间和总住院费用。此外，我们还对 NAC 至手术的间隔时间较短的患者、接受特定 NAC 方案的患者和接受特定手术的患者进行了三次敏感性分析。
总的来说，术后并发症的发生率为 6.0%，NAC 至手术的中位间隔时间为 31（四分位间距，24-39）天。两组患者在并发症（比值比，0.95；95%置信区间，0.88-1.04）方面，包括局部和全身并发症方面，差异无统计学意义。NAC 与麻醉持续时间缩短和总住院费用降低显著相关。敏感性分析显示了类似的结果。
我们的匹配对队列分析显示，对于接受 NAC 治疗的乳腺癌患者和未接受 NAC 治疗的患者，无论间隔时间、方案和手术过程如何，术后并发症均无显著差异。患者可以安全地接受手术和 NAC，而无需延长间隔时间。
